Make Sure Who You Hire

Are you routinely checking the OIG's list of excluded individuals or entities (the LEIE)? If not, it should be part of your regular background check when you hire new employees — and an ongoing check as part of your HME company's corporate compliance procedures. You shouldn't limit the search only to your employees, either. You should also check referring physicians, sales reps and subcontractors.

The law enforcement arm of the Department of Health and Human Services is the Office of Inspector General. Part of the OIG's authority is to exclude individuals and entities from participation in federally funded health care programs, such as Medicare and Medicaid.

Why Is This Important?

When an individual is excluded from participation, it means just that. First, if you hire an individual or entity that has been excluded, and they perform services for Medicare or Medicaid patients, then those claims cannot be reimbursed. The primary effect of exclusion is that no payment will be provided for any items furnished, ordered or prescribed by an excluded individual or entity. Therefore, excluded persons cannot be involved in any part of the process of providing services to Medicare or Medicaid patients.

Even more important, if the OIG feels that you knowingly submitted claims for reimbursement when an excluded individual or entity was involved, you can be subject to civil monetary penalties (CMPs) for doing so. In fact, you can be subject to CMPs just for hiring an excluded person — and the penalties are steep.

A provider can be charged a fine of $10,000 for each claim, as well as three times the amount charged, if the department feels the supplier knew or should have known the person was excluded. Is that a risk you're willing to take? The only way for you to know for sure is to conduct routine checks of the LEIE database.

Further, the OIG has provided guidance to medical equipment suppliers in implementing an effective compliance program. As part of this guidance, the OIG clearly noted that one of the dedicated compliance officer's primary responsibilities is to ensure that all employees and independent contractors have been checked on the OIG exclusion list. I highly recommend not only checking the list but keeping a copy of the search in your employee files. Then, on a regular basis, go back and do follow-up checks.